When helping your clients who are moving from a Kaiser Permanente Individual and Family plan to a Medicare Advantage or group plan and their spouse or domestic partner needs to remain on an individual plan, please keep in mind:
- For the spouse or domestic partner who needs to remain on an individual plan, they will need to complete a NEW application – Kaiser Permanente cannot roll them over from being a dependent to the subscriber of the existing individual policy.
- Enrollment can be done online through Sign Me Up (SMU) or by completing a paper application for off-exchange.
- Coverage start date is first of the month following receipt of the completed application – if continuous coverage is needed, the application will need to be submitted prior to the cancellation of the existing individual policy.
- When moving from an individual plan to Medicare or a group plan or changing plans from off-exchange to on-exchange or vice versa, clients will proactively need to cancel their existing plan. By not cancelling the existing plan, the client will be set up on dual coverage and will be billed for both plans.
- Off-exchange clients can request cancellation by completing and sending in the Account Change Form (ACF), by sending in writing the request to cancel, or by calling Member Services at 1-800-290-8900.
- On-exchange clients can request cancellation by selecting this option on their Washington Healthplanfinder dashboard or by contacting their Customer Support Center.
- Autopay will not automatically cancel and or adjust when moving from an individual plan to a Medicare Advantage plan or when moving from on to off exchange or vice versa. Your client may need to adjust an existing autopay set up to ensure autopay is pulled correctly or cancel it before their new Medicare Advantage plan coverage starts.
- During a Special Enrollment Period (SEP), clients should submit their proof with their application, or within 10 days of submitting their application to prevent delays in processing or cancelation of their application. Kaiser Permanente Washington requires documentation to support the qualifying life event for both on and off-exchange. To learn what types of proof are accepted, visit kp.org/specialenrollment.
Proof for SEP enrollment can be sent by mail or fax:
Kaiser Permanente for Individuals and Families
P.O. Box 23127
San Diego, CA 92193-9921
Fax – 1-855-355-5334
- On and off-exchange premium payment timelines are as follows:
- Binder payment /first month’s premium is due by the enrollment effective date or 30 calendar days from Kaiser Permanente receiving the application, whichever is later.
- Subsequent monthly premium payments are due by the last day of the month preceding the coverage month.
Grace period timelines are as follows:
- Three months for clients who receive financial assistance (Affordable Care Act advance premium tax credits or Washington Cascade Care Savings).
- One month for clients who do not receive financial assistance.
Note: Delinquency grace periods don’t apply to the first binder payment and are used when a member is late on monthly premium payments.
Need support or help? Contact the Kaiser Permanente Washington Individual and Family Sales and Producer Support team at 1‑800‑474‑1079, Monday through Friday, 8:30am to 5pm Pacific Time.